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Revisiting the Montreal Cognitive Assessment in a European cohort of elderly living with type 2 diabetes
Nataša Popović, Noemi Lois, Santiago Pérez‐Hoyos, Rafael Simó, Lieza Geertje Exalto. Journal of Alzheimer s Disease, 2025-03-01
Topic: Risk, prevention and care in population studies
BackgroundIndividuals with type 2 diabetes have an increased risk of developing both vascular and Alzheimer's dementia.ObjectiveThis prospective cross-sectional study assessed the screening ability of the standard Montreal Cognitive Assessment (MoCA) score suggestive of mild cognitive impairment (<26) in a European cohort of individuals ≥65 of age with type 2 diabetes.MethodsParticipants of RECOGNISED, a European prospective EU-funded cohort study, were screened using MoCA. In addition, a 13-item Neuropsychological Test Battery (NTB) with the Clinical Dementia Rating was undertaken to categorize participants as normocognitive (NC, n = 128) or mild cognitive impaired (MCI, n = 185). Receiver operating characteristic (ROC) analysis was used to evaluate the ability of MoCA cut-off scores to categorize patients as having MCI or not.ResultsThe standard MoCA cut-off of 25/26 demonstrated a sensitivity of 88% and a specificity of 51%, resulting in a false positive rate of 20%. ROC analysis showed that a MoCA cut-off of 24/25 has a better balance between sensitivity (81%) and specificity (62%), with a lower false positive rate of 16%. NTB results showed that the MCI group had the lowest norm-referenced percentile scores in the visuo-construction domain, a known early feature of Alzheimer's disease and a significant predictor of a rapid rate of disease progression.ConclusionsMoCA as a screening tool in individuals ≥65 with type 2 diabetes, overestimates the prevalence of MCI, even when applying lower cut-offs. More specific screening strategies are necessary, particularly targeting the visuo-construction domain, to effectively identify cognitive impairment in individuals with type 2 diabetes.
Key findings
- BackgroundIndividuals with type 2 diabetes have an increased risk of developing both vascular and Alzheimer's dementia.ObjectiveThis prospective cross-sectional study assessed the screening ability of the standard Montreal Cognitive Assessment (MoCA) score suggestive of mild cognitive impairment (<26) in a European cohort of individuals ≥65 of age with type 2 diabetes.MethodsParticipants of RECOGNISED, a European prospective EU-funded cohort study, were screened using MoCA.
- Receiver operating characteristic (ROC) analysis was used to evaluate the ability of MoCA cut-off scores to categorize patients as having MCI or not.ResultsThe standard MoCA cut-off of 25/26 demonstrated a sensitivity of 88% and a specificity of 51%, resulting in a false positive rate of 20%.
- ROC analysis showed that a MoCA cut-off of 24/25 has a better balance between sensitivity (81%) and specificity (62%), with a lower false positive rate of 16%.
- NTB results showed that the MCI group had the lowest norm-referenced percentile scores in the visuo-construction domain, a known early feature of Alzheimer's disease and a significant predictor of a rapid rate of disease progression.ConclusionsMoCA as a screening tool in individuals ≥65 with type 2 diabetes, overestimates the prevalence of MCI, even when applying lower cut-offs.
Why it matters
This study assessed the Montreal Cognitive Assessment in older adults with type 2 diabetes and found that a lower cut-off improved the balance between sensitivity and specificity for detecting mild cognitive impairment. It is about screening accuracy, not about treating, curing, or preventing Alzheimer's disease.
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Study details
- Study designcohort study
- Participants128
- Evidence strengthModerate
How this study scored 52/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for effect reported and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of Alzheimer s Disease) |
| Journal's citation record | 2 / 4 | Journal of Alzheimer s Disease: journal h-index 218 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 2 / 4 | 128 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 1 / 7 | Cited 4 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 1.3 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 2 / 6 | Cited 2.5× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 1 / 4 | Cited 4 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Lieza Geertje Exalto: h-index 21 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | University Medical Center Utrecht: institution h-index 1,076 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 7 institution(s) in 4 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40025711) |
| Free to read | 2 / 2 | Free to read |
| Total | 52 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1177/13872877251318029
- PubMed: 40025711
- Original source →
- Free full text: Utrecht University Repository (Utrecht University) →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Popović, N., Lois, N., Pérez‐Hoyos, S., Simó, R., & Exalto, L. G. (2025). Revisiting the Montreal Cognitive Assessment in a European cohort of elderly living with type 2 diabetes. Journal of Alzheimer s Disease. https://doi.org/10.1177/13872877251318029
Vancouver
Popović N, Lois N, Pérez‐Hoyos S, Simó R, Exalto LG. Revisiting the Montreal Cognitive Assessment in a European cohort of elderly living with type 2 diabetes. Journal of Alzheimer s Disease. 2025. doi:10.1177/13872877251318029. PMID: 40025711.
BibTeX
@article{popovic2025-40025711,
author = {Popović, Nataša and Lois, Noemi and Pérez‐Hoyos, Santiago and Simó, Rafael and Exalto, Lieza Geertje},
title = {{Revisiting the Montreal Cognitive Assessment in a European cohort of elderly living with type 2 diabetes}},
journal = {Journal of Alzheimer s Disease},
year = {2025},
doi = {10.1177/13872877251318029},
pmid = {40025711},
url = {https://doi.org/10.1177/13872877251318029}
}
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